Endoscopic biliary drainage in patients with cholangiocarcinoma – self-expanding metal <i>versus</i> polyethylene stents

<b>Background:</b> Endoscopic biliary drainage is the standard of care for patients with cholangiocarcinoma (CCA)-induced, obstructive jaundice. Self-expanding metal stents are supposed to be superior to polyethylene stents in terms of reduction of interventions and costs. So far, there are only few real-life data with respect to stent selection and survival in this patient cohort. <b>Methods:</b> In this study, we retrospectively analyzed patients with CCA treated with endoscopic biliary drainage from 2000 to 2015 at Hannover Medical School, Germany. The aim of this study was to analyze whether metal stenting reduces the frequency of interventions and influences survival in a large, real-life cohort. <b>Results:</b> Overall, 422 patients with CCA were included in this study. Indication for endoscopic biliary drainage was most often obstructive jaundice (<i>n</i> = 397; 94.1%). Among these patients, 20 patients (5%) were initially treated with a metal stent and 38 (9.6%) received a metal stent in the subsequent course. Median number of interventions per month was 2.4-fold reduced following metal stenting. Patients first treated with a metal stent had a more advanced tumor stage and a significantly shorter median overall survival (mOS) compared to patients who received a metal stent subsequently (7.5 months <i>vs</i>. 15.2 months; <i>p</i>=.019). There was no difference in mOS for metal <i>vs</i>. polyethylene stenting following a propensity score match for the confounders curative resection and chemotherapy (13.2 <i>vs</i>. 13.7 months, <i>p</i>=.555). <b>Conclusions:</b> Our data confirm that metal stenting reduces the frequency of interventions, but does not influence OS. Metal stenting should be considered specifically in younger patients who are suitable for chemotherapy.

<b>研究背景:</b> 内镜下胆道引流（endoscopic biliary drainage）是胆管癌（cholangiocarcinoma, CCA）所致梗阻性黄疸患者的标准治疗方案。自膨式金属支架（self-expanding metal stents）在减少干预次数与医疗成本方面，被认为优于聚乙烯支架（polyethylene stents）。截至目前，针对该患者队列的支架选择与生存预后相关的真实世界数据仍较为匮乏。
<b>研究方法:</b> 本研究回顾性分析了2000年至2015年间，德国汉诺威医学院收治的接受内镜下胆道引流治疗的胆管癌患者数据。本研究旨在探索在大型真实世界队列中，金属支架置入是否可减少干预次数并对患者生存产生影响。
<b>研究结果:</b> 本研究共纳入422例胆管癌患者。内镜下胆道引流的最常见指征为梗阻性黄疸（n=397；94.1%）。其中20例患者（5%）初始治疗即采用金属支架置入，另有38例患者（9.6%）在后续治疗过程中接受了金属支架置入。金属支架置入后，每月干预次数的中位数降低了2.4倍。与后续接受金属支架置入的患者相比，初始即接受金属支架置入的患者肿瘤分期更晚，中位总生存期（median overall survival, mOS）显著更短（7.5个月 vs 15.2个月；p=0.019）。经针对根治性切除与化疗这两个混杂因素进行倾向得分匹配（propensity score match）后，金属支架与聚乙烯支架置入患者的中位总生存期无显著差异（13.2个月 vs 13.7个月，p=0.555）。
<b>研究结论:</b> 本研究数据证实，金属支架置入可减少干预次数，但对患者总生存期（overall survival, OS）无显著影响。金属支架置入可作为适合化疗的年轻患者的优选治疗方案。

搜集汇总

背景与挑战

背景概述

该数据集总结了胆管癌患者内镜胆道引流的研究，比较了自扩张金属支架与聚乙烯支架的效果。基于2000年至2015年德国汉诺威医学院的回顾性分析，包含422名患者数据，结果显示金属支架显著减少干预频率（每月干预次数减少2.4倍），但未影响总生存期。结论建议金属支架适用于适合化疗的年轻患者，以降低干预需求。